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Domestic Violence screening and intervention programmes for adults with dental or facial injury
Abstract
There is no evidence to support or refute the effectiveness of screening and intervention programmes detecting and supporting victims of domestic violence with dental or facial injuries Many studies highlighted difficulty in measuring domestic violence because of underreporting. Screening may be helpful to identify victims of domestic violence. Screening tools exist but no studies have evaluated their effectiveness. Dentist and oral and maxillofacial surgeons are not generally trained to intervene in situations involving domestic violence. Referral to specialist agencies for intervention maybe a better option. Many intervention programmes exist either to support, reduce and/or prevent domestic violence. However, the effectiveness or harms of these intervention programmes at reducing violence have not been properly investigated in healthcare settings.
... Protocolos foram estabelecidos 9,13,18 com: 1) perguntas objetivas que contemplem informações relativas à agressão; 2) condutas profissionais que validem qualquer tipo de violência como prática ilegítima (reiterando que é um ato condenável, impróprio e uma questão de saúde a ser combatida essas ações fortalecem a confiança entre paciente-CD); 3) preenchimento criterioso da documentação com descrições e anotações nas próprias palavras da paciente, salientando datas, tipo de agressão, uso ou não de objetos, tempo decorrido até o atendimento odontológico e outros 7 estes registros são essenciais para reduzir subnotificações e podem servir como provas periciais 8 ; 4) orientação sobre redes de apoio e centros de referência locais e regionais, informando endereços e telefones, visto que não é aceitável simplesmente indicar outro serviço 25 . ...
... Neste contexto, o profissional CD, formado e/ou em formação, passa a fazer parte da rede de apoio de enfrentamento à violência contra a mulher 13,29 quando o delineamento do plano de ensino para a integração ensino-serviçocomunidade é construído coletivamente com interferências afirmativas na comunidade 6 acadêmica e científica para iniciar e promover mudanças consistentes 16,30 . Para alcançar tais mudanças, atitudes essenciais devem permear a expertise dos CDs continuadamente 13,15,25 , por exemplo, expansão do conhecimento, respeito à autonomia da paciente (independente de raça, religião ou nível de escolaridade), alteridade e constante discussão multiprofissional sobre temas de abrangência sociais 16,26,27 . ...
O desempenho de atributos profissionais de integralidade do atendimento de mulheres em situação de violência depende de como os cirurgiões-dentistas (CDs) estruturam suas práticas de cuidado e como compreendem a violência. Por isso, o objetivo desta revisão foi acumular evidências da responsabilidade profissional e obrigações sociais do CD e sua imprescindibilidade no enfrentamento da violência contra a mulher. Foram selecionados artigos nas bases de dados PubMed, SciELO e LILACS, a partir de Descritores em Ciências da Saúde, para fundamentar e aprofundar as perspectivas sobre a integralidade do atendimento odontológico, considerando os conflitos sociais subentendidos na queixa principal. Constatou-se que a violência contra a mulher é resultante de processos históricos-sociais de desigualdade entre os gêneros; a agressão física sobressai-se entre as principais queixas e mulheres agredidas por seu parceiro têm alta prevalência de sofrer injúrias na cabeça e na face. As sequelas da violência vão além dos vestígios físicos e difundem-se a inúmeros problemas orais. Verificou-se pouca aptidão dos cirurgiõesdentistas para identificar, conduzir e propor alternativas de tratamento global à paciente, mesmo com protocolos para naturalização da investigação por meio da anamnese. A ampliação do conhecimento e discussão das políticas de ensino são oportunidades para consolidar a humanização e a integralidade de saúde, evitando exames e tratamentos mecânicos, sem afeto ou respeito. Essa estratégia faz parte da construção coletiva para o estabelecimento e manutenção do compromisso ético e social do Ensino em Odontologia, em que o CD compreende a magnitude de sua profissão e presta seus serviços articuladocom a realidade social.
... 11 There may also be misconceptions and lack of awareness about the role of dentists and dental care professionals in supporting patients experiencing DVA. 12 Furthermore, there is a dearth of research on the effectiveness of domestic violence interventions within dentistry. 13 An evidence-based programme of practice training and a referral pathway to DVA advocacy has been developed with general medical practices (GMPs) and is commissioned in over 40 areas nationally. ...
Objectives Assess the feasibility of using the Identification and Referral to Improve Safety (IRIS) intervention in a general dental practice setting and evaluating it using a cluster randomised trial design. IRIS is currently used in general medical practices to aid recognition and support referral into specialist support of adults presenting with injuries and other presenting factors that might have resulted from domestic violence and abuse. Also, to explore the feasibility of a cluster randomised trial design to evaluate the adapted IRIS.
Design Feasibility study for a cluster randomised trial of a practice-based intervention.
Setting Greater Manchester general dental practices.
Results It was feasible to adapt the IRIS intervention used in general medical practices to general dental practices in terms of training the clinical team and establishing a direct referral pathway to a designated advocate educator. General dental practices were keen to adopt the intervention, discuss with patients when presented with the opportunity and utilise the referral pathway. However, we could not use practice IT software prompts and data collection as for general practitioners because there is no unified dental IT system and because coding in dentistry for diagnoses, procedures and outcomes is not developed in the UK.
Conclusion While it was feasible to adapt elements of the IRIS intervention to general dental practice and there was general acceptability, we did not have enough empirical data to plan a definitive cluster randomised trial design to evaluate the IRIS-dentistry intervention within general dental practices.
... In particular, numerous reviews located effectiveness for identification strategies specific to women of reproductive age (Curry et al., 2018;Feltner et al., 2018;Vogel, 2013;Wilson et al., 2014), with several reviews focusing on prenatal care contexts (Daley et al., 2020;Hooker et al., 2012;LoGiudice, 2015). Another review identified that dental or facial injury could be a salient opportunity for IPV identification, whether in emergency department or dental treatment contexts (Coulthard et al., 2015). As important as it is for clinical practices to create opportunities for identification and disclosure, it is also the case that for many women, pregnancy is a turning point in their experiences of abuse, with these experiences often intensifying and escalating in their harm (Yakubovich et al., 2018). ...
Purpose
Healthcare settings remain important contexts for the identification of intimate partner violence (IPV); however, identification strategies for IPV are diverse and work in complex ways that may differ across contexts. To understand how, rather than if, IPV identification strategies work, we undertook a systematic review of reviews with realist synthesis.Methods
We undertook a search of five databases for full-text, peer-reviewed systematic reviews addressing identification strategies for IPV in healthcare contexts. We screened titles and full texts in duplicate and independently, appraised included systematic reviews and synthesized them using methods from realist synthesis to develop context-mechanism-outcome configurations (CMOCs).ResultsWe included 29 reviews reported in 32 publications. Our findings were summarized in four CMOCs at system, system–clinician, clinician and patient levels. CMOCs underscored the role of supportive clinical and practice contexts, patient-provider relationships and continuity of care to ensure the benefits, and reduce the potential harms, of a range of identification strategies. CMOCs also highlighted the importance of supporting clinicians through clinical policies and protocols to ensure a consistent, safe and effective response to IPV.Conclusions
Future work should address how supportive clinical contexts that facilitate effective inquiry, disclosure, and referral to services can be created, acknowledging that what works in one context may not work in another. Included systematic reviews did not permit exploration of how racial and ethnic diversity relate to identification strategies. This is an area requiring urgent research to inform clinical practice.
... A systematic review by Babcock, Green, and Robie (2004) raised questions about these programs and attracted the attention of many in the field. A series of reviews and meta-analyzes have been conducted since, (Akoensi, Koehler, Lösel, & Humphreys, 2012;Coulthard et al., 2010;L. Feder, Wilson, & Austin, 2008;Ferrer-Perez & Bosch-Fiol, 2016;Smedslund, Dalsbø, Steiro, Winsvold, & Clench-Aas, 2011). ...
Advocacy services, for victims and survivors, are at the core of our response to Intimate Partner Violence (IPV). The survivor contact element of IPV perpetrator programs is recognized as a necessary safety measure for their operation. Within the context of equivocal evaluations of these programs, and the impetus to find opportunities to enhance their effectiveness, this study report explores the service user perspective on survivor contact work. In-depth semi-structured interviews were completed with 18 perpetrators and 18 survivors involved in three Irish-based programs, and findings were analyzed using grounded theory principles. Almost without exception, survivors were positive about their engagement with an outreach service. There was evidence to suggest that perpetrator program outreach services do reach survivors who may not ordinarily make contact with an advocacy service. In general terms, survivors felt validated as survivors, they felt supported, they learned about abusive behaviors and some saw the service as a monitor of what their partner was saying during group work. However, some survivors described their fear that any reports of ongoing abuse, which they offered, would attract reprisals from their partner or the attentions of child protection services. More determined application of criminal justice measures, and enhanced resourcing of the survivor contact element of these programs, should be considered.
... A systematic review by Babcock, Green, and Robie (2004) which was ambivalent about their usefulness, attracted the attention of many in the field. Since then, a series of reviews and meta-analyses have been conducted (Akoensi, Koehler, Lösel, & Humphreys, 2012;Coulthard et al., 2010;Feder, Wilson, & Austin, 2008;Ferrer-Perez & Bosch-Fiol, 2018;Smedslund, Dalsbø, Steiro, Winsvold, & Clench-Aas, 2011). None of these have offered clear direction on the harm or benefits of any particular variation of the traditional manualized group-work program, despite the development of curriculums in line with ascendant therapeutic modes such as psycho-education (Rosenbaum, Gearan, & Ondovic, 2001), cognitive behavioral therapy (Easton et al., 2007), and dialectical behavior therapy (Fruzzetti & Levensky, 2000). ...
This study investigated the process of change in intimate partner violence (IPV) perpetrators through in-depth interviews with their (ex-)partners. Programs designed to help perpetrators change their behavior, have yet to be endorsed by rigorous evaluation. In this context, this study explored survivors’ perspectives for direction on how these programs might be further developed. Interviews were conducted with 18 IPV survivors, who had recently had the experience of having a (ex-)partner complete a perpetrator program. The study employed iterative data collection and analysis, in keeping with the grounded theory approach to qualitative research. Researchers used secondary coding to enhance study rigor. Lines of enquiry which were relevant to perpetrator program development were identified in an expert review of interim findings, after nine interviews. Survivors described change on a spectrum, from highly significant change, through uncertainty about change, to harmful change. Some survivors described their subscription to new standards of family safety, following the support and time-out they had been afforded during their partners’ treatment. Study findings give us pause to consider what we can realistically hope to achieve through traditionally formatted psycho-educative group-work programs with perpetrators. Survivors described the need for long-term sustained change in perpetrators and genuine feelings of safety for themselves and their children. We discuss the role the current perpetrator programs might play in achieving these aims and point toward the inadequacy of commonly used behavior-counting tools in program evaluations. Based on the current study findings, we suggest that perpetrator programs can become perpetrator centric, and stray from their original conceptualisation as just one part of an integrated response to IPV. We lend support to calls for the use of survivor safety, and well-being measures, in program evaluations.
... 1 The increase in violence and in the number of traffic accidents and the more frequent participation of children in sports activities contribute to the transformation of traumatic dental injuries into an emerging public health problem. [2][3][4] Various studies on health education strategies have emphasized the importance of evaluating knowledge about traumatic dental injuries in different settings, such as home, schools, and streets, and in different groups that exert a broad influence such as teachers, 5,6 students, 1 dentists, 7-9 physicians, 10,11 parents, 12,13 and athletes. 14,15 In Brazil, community health workers (CHWs) are professionals who can reach a wide variety of people and who have a marked influence on prevention and health promotion strategies in view of their ability to communicate with people and their natural leadership in the work environment. ...
Background:
The international literature emphasizes the importance of evaluating the knowledge of different groups such as teachers, students, dentists, physicians, parents, and athletes regarding dental injuries. In Brazil, community health workers are professionals who can reach a wide variety of people and who have a marked influence on prevention and health promotion strategies. The objective of this study was to investigate the knowledge and attitudes of community health workers regarding dental trauma.
Methods:
A questionnaire consisting of 19 questions divided into 3 parts was applied: demographic characteristics, knowledge, and attitudes. Data from 206 respondents were analyzed using descriptive statistics and logistic regression models.
Results:
Approximately 28% of the participants reported to have been called to assist individuals with dental trauma. Only 42 subjects had received education on dental injuries, with 34 of them being instructed by a dentist. In cases of tooth avulsion, only 1.9% of the health workers reported that they would search for the tooth and reimplant it. The most frequently indicated storage media for avulsed teeth were nonphysiological media (69.42%).
Conclusions:
The educational level of the community health workers somehow influenced their knowledge (P < 0.001) and attitude (P = 0.016) regarding dental injuries. Educational programs for this group are needed to improve the management of traumatic dental injuries.
... The lower face -the mandible. Maxillofacial trauma is usually caused by [1] assault (most common); domestic violence is an important cause [2] (alcohol may be involved), road traffic accidents (midface fractures), falls and sports injuries. The fracture ratio mandibular: zygoma:maxillary is 6:2:1. ...
Mandibular trauma are a frequent injury of maxillofacial skeleton due to the mandible's prominence and relative lack of support. Maxillofacial injuries can be complex and can involve the skin and soft-tissues as well as bones resulting in fractures. Although, several cases of severe crush injury of the lower jaw have already been presented but total avulsion of mandible has rarely been reported. As with any facial fracture, consideration must be given for the need of emergency treatment to secure the airway or to obtain hemostasis if necessary before initiating definitive treatment. We presents a case report of completely avulsed mandible along with soft-tissue of midface region in pediatric patient following trauma, which was attempted to manage or repaired by successful microvascular surgical technique. Unfortunately, we lost the patient in next postoperative day due to cardiac complication. Avulsion of the lower jaw may further complicate the obstructive nature of the upper airway. Multi-specialty involvement in their management may be needed for management of such type of avulsion injury.
... Thirteen bibliographic databases (MEDLINE, EMBASE, Global Health, PsycINFO, the Health Management Information Consortium database [HMIC], Social Policy and Practice, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], the International Bibliography of the Social Sciences [IBSS], Web of Science, Africa Web, Index Medicus for South-East Asia Region [IMSEAR], Index Medicus for the Eastern Mediterranean Region [IMEMR], and Latin American and Caribbean Health Sciences Literature [LILACS]) were searched using controlled vocabulary terms and key/text words from first record to 23 October 2013. Terms for IPV and MSM were adapted from Cochrane protocols and peer-reviewed systematic reviews24252627. Terms for mental disorders were adapted from a review by Trevillion and colleagues [5]. ...
Intimate partner violence (IPV) among men who have sex with men (MSM) is a significant problem. Little is known about the association between IPV and health for MSM. We aimed to estimate the association between experience and perpetration of IPV, and various health conditions and sexual risk behaviours among MSM.
We searched 13 electronic databases up to 23 October 2013 to identify research studies reporting the odds of health conditions or sexual risk behaviours for MSM experiencing or perpetrating IPV. Nineteen studies with 13,797 participants were included in the review. Random effects meta-analyses were performed to estimate pooled odds ratios (ORs). Exposure to IPV as a victim was associated with increased odds of substance use (OR = 1.88, 95% CIOR 1.59-2.22, I2 = 46.9%, 95% CII2 0%-78%), being HIV positive (OR = 1.46, 95% CIOR 1.26-1.69, I2 = 0.0%, 95% CII2 0%-62%), reporting depressive symptoms (OR = 1.52, 95% CIOR 1.24-1.86, I2 = 9.9%, 95% CII2 0%-91%), and engagement in unprotected anal sex (OR = 1.72, 95% CIOR 1.44-2.05, I2 = 0.0%, 95% CII2 0%-68%). Perpetration of IPV was associated with increased odds of substance use (OR = 1.99, 95% CIOR 1.33-2.99, I2 = 73.1%). These results should be interpreted with caution because of methodological weaknesses such as the lack of validated tools to measure IPV in this population and the diversity of recall periods and key outcomes in the identified studies.
MSM who are victims of IPV are more likely to engage in substance use, suffer from depressive symptoms, be HIV positive, and engage in unprotected anal sex. MSM who perpetrate IPV are more likely to engage in substance use. Our results highlight the need for research into effective interventions to prevent IPV in MSM, as well as the importance of providing health care professionals with training in how to address issues of IPV among MSM and the need to raise awareness of local and national support services. Please see later in the article for the Editors' Summary.
... Existing intervention studies focused on pregnant women, and study limitations restrict their interpretation. Coulthard et al., 2004 Dental and oral and maxillofacial practice; ...
Many efforts to reduce family violence are documented in the published literature. We conducted a systematic review of interventions intended to prevent family violence in Aboriginal communities. We retrieved studies published up to October 2009; 506 papers included one systematic review, two randomized controlled trials, and fourteen nonrandomized studies or reviews. Two reviews discussed interventions relevant to primary prevention (reducing the risk factors for family violence), including parenting, role modelling, and active participation. More studies addressed secondary prevention (where risk factors exist, reducing outbreaks of violence) such as restriction on the trading hours for take away alcohol and home visiting programs for high risk families. Examples of tertiary prevention (preventing recurrence) include traditional healing circles and group counselling. Most studies contributed a low level of evidence.
... The term IPV has been used interchangeably with domestic violence (DV) [3]. However, in more recent years, DV has developed a broader meaning, and now includes abuse that occurs in any relationship within a household, including that among children, elders, or siblings [4]. ...
The facial region has been the most common site of injury following violent episodes. The purpose of this study was to determine the prevalence and pattern of maxillofacial injuries associated with intimate partner violence (IPV) in women treated at a single facility in Malaysia.
A retrospective review of 242 hospital records of female IPV victims who were seen at the One-Stop Crisis Centre (OSCC) in Hospital Raja Perempuan Zainab II, Kelantan over a two-year period (January 1, 2005 to December 31, 2006) was performed. A structured form was used for data collection. Information regarding the anatomical sites of injuries, types of injuries, and mechanisms of assault were obtained.
Most victims were married (85.1%), were injured by the husband (83.5%), and had at least one previous IPV episode (85.5%). Injury to the maxillofacial region was the most common (50.4%), followed by injury to the limbs (47.9%). In 122 cases of maxillofacial injuries, the middle of the face was most frequently affected (60.6%), either alone or in combination with the upper or lower third of the face. Injury to soft tissues (contusions, abrasions and lacerations) was the most common (87.7%).
This study indicates there is a high prevalence of maxillofacial injuries associated with IPV among women treated at the OSCC in Kelantan, Malaysia.
... There was a female predilection (male to female ratio = 1:2) (Table II). The female predilection may be related to the main cause of the trauma, i.e. hetero- aggression some of them in family environment, as previously reported [2]. Most of the patients were young (63.16% of the patients being 20-39 years old), also in conjecture with cause of the trauma (Table III). ...
Several patients with head and neck disorders are incidentally diagnosed during clinical examination for traumatic events. Our study refers to 76 patients with head and neck trauma evaluated in the emergency ward of Phonoaudiology and ENT Functional Surgery Dr. Dorin Hociota Institute in 2007. During routine ENT consultation, 13 patients were identified with trauma unrelated lesions: nasal septum deviations (5 cases), basal cell carcinomas (3 cases), lentiginous malignant melanoma, keratoacantoma, branchial cyst, nasal lobular capillary hemangioma, squamous cell carcinoma of the tongue (one case each). We strongly recommend ENT examination in patients with head and neck trauma not only for establishing the gravity and the extend of the traumatic lesions in the forensic approach but also for revealing unknown underlying disease in some cases with incredible results for the well-being of the patient.
... Women who suddenly leave their partners may be exposed to an increased risk of assault (97). Practitioners should instead provide information on how to contact the appropriate local services (98). Also the additional information about 'Child physical abuse' could be found (26). ...
During the past 30 years, the number of aetiologies of traumatic dental injuries (TDIs) has increased dramatically in the literature and now includes a broad spectrum of variables, including oral and environmental factors and human behaviour. The aim of this study is to present an international review of well-known as well as less well-known unintentional and intentional causes of TDIs. Moreover, some models that are useful in investigating contact sport injuries are presented.
The databases of Medline, Cochrane, Social Citation Index, Science Citation Index and CINAHL from 1995 to the present were used.
Oral factors (increased overjet with protrusion), environmental determinants (material deprivation) and human behaviour (risk-taking children, children being bullied, emotionally stressful conditions, obesity and attention-deficit hyperactivity disorder) were found to increase the risk for TDIs. Other factors increasing the risk for TDIs are presence of illness, learning difficulties, physical limitations and inappropriate use of teeth. A new cause of TDIs that is of particular interest is oral piercing. In traffic facial injury was similar in unrestrained occupants (no seat belts) and occupants restrained only with an air bag. Amateur athletes have been found to suffer from TDIs more often than professional athletes. Falls and collisions mask intentional TDIs, such as physical abuse, assaults and torture. Violence has increased in severity during the past few decades and its role has been underestimated when looking at intentional vs unintentional TDIs. There are useful models to prevent TDIs from occurring in sports. WHO Healthy Cities and WHO Health Promoting Schools Programmes offer a broad solution for dental trauma as a public health problem.
The number of known causes of TDIs has grown to alarming levels, probably because of increased interest of the causes and the underlying complexity of a TDI. Accepted oral, environmental and human aetiological factors must therefore be included in the registration of TDIs.
Background/Aims
Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV.
Methods
The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin‐roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses.
Results
Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta‐analyses showed an overall prevalence of 29% (95% CI: 15%–48%, I ² = 99%) and 4% (95% CI: 1%–10%, I ² = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%–46%, I ² = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%).
Conclusion
The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).
Background: Intimate partner violence (IPV) has previously been recognized as a major public health issue. Oral healthcare providers, such as dentists, are crucial to the screening and identifying of individuals experiencing IPV, since most injuries occur in the head and neck region. A lack of knowledge and awareness regarding teaching and learning about IPV in dental school curricula has been identified. Based upon the overall lack of knowledge, the objective of this study was to conduct a longitudinal assessment of knowledge, awareness, and beliefs regarding IPV among dental students in their first year of education. Methods: All students (n = 245) from three consecutive, first-year dental student cohorts (n = 81, n = 82, n = 82) were provided a brief and voluntary in-class survey in conjunction with an instructional workshop. The survey included questions designed to ascertain knowledge, awareness, and beliefs regarding IPV as a healthcare and dental issue before and after the instructional session. Differences in responses to the questions before and after the IPV educational workshop were measured using paired t-tests. Results: A total of n = 232 completed pre- and post-responses were received from all three first-year dental student cohorts (n = 76, n = 80, n = 76), representing an overall 94.6% response rate. Analysis of these data showed that the student population was predominantly male and white (non-minority), aged in their mid- to late twenties, with most students reporting no previous IPV education. The few students reporting previous IPV education were mainly younger (
Objective:
To identify the need for restorative treatment in 12-year-old Brazilian schoolchildren with dental trauma and its association with clinical and socioeconomic factors.
Material and Methods:
A cross-sectional population-based study was carried out with sample composed of 588 12-year-old students from the city of Diamantina, Minas Gerais, Brazil. Data were collected from August to November 2016 through clinical examination, adopting the Andreasen classification and semi-structured questionnaire to verify the etiology and location of the accident that resulted in dental trauma. Statistical analysis included the frequency distribution and bi and multivariate analysis, with 5% significance level.
Results:
The presence of 219 traumatized teeth in 176 students was observed (29.9%). The main lesion was enamel fracture (41.4%), followed by enamel and dentin fracture (39.4%). The presence of restorative treatment was observed only in 11.5% of students. Fall (43.5%) was the most frequent etiology, followed by accidents on the streets (35.8%). Need for treatment was present in 53.4% of adolescents. Statistically significant association between males (p=0.010), severe overjet (p<0.0001) and inadequate lip protection (p<0.0001) and presence of dental trauma was observed. Maternal schooling over 8 years of study was statistically associated with need for restorative treatment (OR = 2.047; CI: 1.099-3.813; p=0.023).
Conclusion:
Prevalence of dental trauma, need for restorative treatment and number of adolescents with no access to restorative treatment in this study were high, point out that the health system is unable to satisfactorily prevent dental trauma and absorb all dental treatment demand resulting from dental trauma.
Objective:
To add to our understanding of change processes by analyzing perpetrators' perspectives on intervention.
Method:
Fourteen databases were searched and 27 articles reporting relevant qualitative findings were identified. Analytic coding was applied across the findings and discussion sections of all 27 study reports to form an interpretive account of the data set. Studies were also grouped according to their perceived theoretical standpoints, and a summary of themes in each grouping is presented.
Findings:
Study participants were largely positive about their experiences in intervention; new learning such as conflict interruption techniques and new communication skills were commonly cited benefits. Perpetrators attend perpetrator intervention programs with a range of motivations, ranging from a determination to change who they are, to a determination to avoid a custodial sentence. The most common barriers to change, found in this analysis, were cognitive distortions, emotional dysregulation, gendered social constructions, and self-esteem issues.
Conclusion:
Further qualitative investigation, of rigor, with the intention-to-treat population of intimate partner violence perpetrators involved in perpetrator programs is needed. At this point, we would venture that qualitative research, with perpetrators, underlines the precept that formidable barriers to change exist in this population. The centrality of group work to perpetrator interventions should be reconsidered in light of the complexity of the change task and in light of the heterogeneity of this population.
Objectives: The aim of this study was to evaluate available knowledge and identify knowledge gaps within the field of oral and maxillofacial surgery, by systematically collecting and evaluating systematic reviews. Twelve specific domains were selected: surgical removal of teeth, antibiotic and corticosteroid prophylaxis, orofacial infections, dental and facial trauma, orthognathic surgery, reconstructive surgery, benign tumors, cysts, premalignant lesions, oral complications of treatment of malignant tumors, hyperbaric oxygen therapy, temporomandibular joint surgery, cost effectiveness of different surgical treatments, and ethics.
Methods: The literature search, covering four databases, was conducted during September 2014: PubMed, The Cochrane library, Centre for Reviews and Dissemination and EBSCO dentistry and oral science source. Retrieved systematic reviews were quality assessed by AMSTAR.
Results: In all, 1,778 abstracts were identified, of which 200 met the inclusion criteria. Forty-five systematic reviews were assessed as of high to moderate quality. The results disclosed some existing evidence in a few domains, such as surgical removal of teeth and implant survival after sinus lifts. However, in all domains, the search revealed a large number of knowledge gaps. Also of concern was the lack of data regarding health economics and ethics.
Conclusions: In conclusion, there is a need for well-conducted clinical research in the fields of oral and maxillofacial surgery.
Background
Injuries sustained to the maxillofacial region can result in significant physical trauma and long lasting psychosocial impairment. Maxillofacial trauma has been reported in literature to be a potentially recurrent disease. Patients who suffer maxillofacial trauma can benefit from psychological support. AimThis study aims to identify maxillofacial trauma patient characteristics, investigate maxillofacial re-injury rate after provision of psychological support and report incidence of post traumatic stress disorder symptoms after maxillofacial trauma. MethodA total of 100 patients were identified from the departmental trauma database over two time periods at Royal Darwin Hospital; 50 patients did not have psychosocial intervention and 50 patients received intervention. Data on demographics, trauma pattern and aetiology were collected. A brief counselling session was conducted on second patient group by a trained mental health nurse and a survey using Trauma Screening Questionnaire was completed one month following injury. ResultsThe most common cause of injuries was assault in both groups followed by falls and the most common site of injuries was in the mandible in both groups. Almost half of all patients were in the15–24 and 25–34 age groups. 17 % of patients in pre-intervention period and 4 % of patients in intervention period had injury recurrence at 3 year follow up. Patient groups at risk of developing post traumatic symptoms included male, non-indigenous population, employed group with no alcohol involvement. Conclusion
Maxillofacial trauma can cause considerable psychological morbidity and expose the patient to high risk of post traumatic disorder symptoms. This type of injury was found to affect particular groups of population and is associated with high rate of recurrence. Psychological support should be provided to these patients as a routine part of trauma aftercare.
This research reviews and discusses the clinical and social science datasets used to identify victims of domestic violence (DV) in the archaeological record. Clinical sources are skewed by law enforcement and cost issues, dominated by Western female data and suggest that DV is a well‐documented form of abuse. Social science sources and perspectives, having arisen from activist movements, are more spatiotemporally diverse in breadth and perspective, and challenge the notion that DV is universal and well‐documented, but are biased because they rely upon self‐survey reports.
Palaeopathology and bioarchaeology have adopted a clinical approach to DV, relying on a pattern of injuries (focussed on the head, face and neck), without critically evaluating whether such datasets are appropriate to the spatiotemporal and socio‐cultural diversity present in the archaeological record. A case study evaluating the injury patterns in 964 post‐medieval adult females from London (England) demonstrates that the majority of injuries that conform to the clinical model have robust alternative explanations, and only a small minority of females have injuries that may have been produced by interpersonal violence, not necessarily DV.
In conclusion, the review highlights that the perspectives of the elderly and male victims are currently neglected in research, and evidence for injury, especially that which may reflect abuse, necessitates interpretation within a ‘web of violence’ approach, as DV does not occur in isolation from other violence in a community. It challenges the ‘check‐list’ approach to interpretation and suggests that a closer examination of fracture mechanism combined with injury patterning may be a more informative approach with which to identify DV victims of both sexes and identifies the need to integrate other health data into the interpretation of violence and abuse. Overall, it concurs with the minority of clinical and forensic literature that it might not be possible to differentiate DV and assault victims. Copyright © 2015 John Wiley & Sons, Ltd.
Violence against Women and Girls (VAWG)
is a pervasive global problem. It is a violation of basic
human rights and a drag on development. Much of the research
to-date on the topic-including a major recent World Health
Organization study to produce global prevalence rates has
focused on better understanding the scale and nature of the
problem. The present study builds on this body or research
while shifting focus to synthesizing global evidence on
potential solutions. This paper, a systematic review of
reviews, breaks new ground by synthesizing evidence on the
effects of VAWG prevention interventions. It examines the
diversity of geographical context, the types of violence
addressed, and the numerous approaches that have been used
to combat VAWG. Additionally the review summarizes the
quality of evidence on efficacy and effectiveness in order
to highlight strengths and gaps of interventions on a global
scale and could serve as a point of reference for those
intending to undertake future design, implementation, and
evaluation of interventions. This paper finds that knowledge
of intervention impacts on VAWG prevention is growing, but
is still highly limited. Nonetheless, a small but growing
body of rigorously tested interventions demonstrates that
preventing VAWG is possible and can achieve large effect
sizes. The interventions with the most positive findings
used multiple, well-integrated approaches and engaged with
multiple stakeholders over time. They also addressed
underlying risk factors for violence, including social norms
regarding gender dynamics and the acceptability of violence.
These examples point to the imperative of greatly increasing
investment both in innovative programming in primary
prevention, as well as in high-quality experimental and
quasi-experimental evaluations to guide international
efforts to end VAWG.
Dans les échelles d’appréciation de la qualité scientifique des recherches, les essais randomisés contrôlés (ERC) figurent en haut de la liste. En termes de crédibilité, dans le courant des pratiques fondées sur des données probantes (Evidence Based Practice [EBP]), les résultats qu’ils obtiennent ont la priorité sur les autres. Les recensions Cochrane, qui portent généralement sur l’efficacité d’interventions médicales, s’intéressent aussi aux interventions de type criminologique. À notre connaissance, aucune étude ne s’est encore penchée sur les conclusions dégagées par la Collaboration Cochrane sur ce type d’intervention. Dans le présent article, le contenu de la revue électronique Cochrane Database of Systematic Reviews a été analysé, pour la période allant de 2000 à 2008. Les résultats montrent que 33 recensions Cochrane ont traité d’interventions de type criminologique. Privilégiant les ERC, ces recensions n’ont retenu en moyenne que 2 % de toutes les études publiées dans différents champs d’intervention. Un tel résultat permet de discuter de la pertinence de la méthode Cochrane pour évaluer l’efficacité d’interventions à caractère plus social. Les questions posées concernent la représentativité des milieux où sont implantées les interventions, la concomitance et la complexité des problèmes à résoudre, les apports et limites des « protocoles » d’intervention, ainsi que les risques de retard, voire de paralysie, dans l’implantation d’approches innovantes.
The Cochrane Oral Health Group (COHG) was formed in 1994 with the aim of producing systematic reviews that primarily include oral health randomized controlled trials (RCTs). The purpose of this cross-sectional study was to characterize reviews published by the COHG. In September 2013, the COHG database was accessed, and all publications were downloaded. Reviews with no studies identified according to the inclusion criteria were labeled "empty reviews." The complete Cochrane database included a total of 5,697 reviews, of which the COHG database included 142 reviews. Of these 142, 69 (48.6%) did not reach a conclusion, including 20 (14.1%) that were identified as empty reviews. Of the 122 non-empty reviews, 116 (95.1%) were based exclusively on RCTs. The median number of RCTs and patients included in the non-empty reviews were seven and 489, respectively. The median number of included RCTs and patients for reviews that reached conclusions were 12 and 934, respectively, and there were five RCTs and 211 patients for reviews without conclusions. Overall, the characteristics of the Cochrane oral health reviews (OH-CSRs) were similar to Cochrane reviews published in other disciplines (All-CSRs). The authors observed a significant difference in the median number of RCTs and patients included when reviews that reached conclusions were separated from those that did not. A greater proportion of empty reviews were present in OH-CSRs compared with All-CSRs. Turning the Cochrane reviews into a tool that is more relevant in clinical practice will require implementation of a methodology allowing inclusion of non-RCTs while controlling for possible bias.
Background:
Urethrocutaneous fistulae (UCFs) represent one of the most frequent causes of morbidity after urethroplasty. Hypospadias can be repaired using different surgical techniques, but-regardless of technique-the incidence of UCF ranges between 10% and 40%. Surgical repair of UCF remains the treatment of choice, even if some patients need further surgery because of recurrences. Cyanoacrylates have been used as skin suture substitutes, and some evidence suggests a beneficial effect when these adhesives are used as an adjuvant in the management of UCF. Here we describe the results of management of UCF using 2-octyl cyanoacrylate (OCA) compared with surgical repair.
Methods:
A randomized clinical trial conducted from January 2008 to December 2012 included 42 children with UCF complications after urethroplasty for hypospadias. Twenty-one children were assigned to receive OCA as ambulatory patients and 21 were treated surgically. The main outcome variable was closure of the UCF. The estimated costs of both treatments were also calculated, as were absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT) to prevent a surgical intervention.
Results:
The mean numbers of UCF were 1.3 in the OCA group (n = 28) and 1.1 in the surgical group (n = 25) with no statistically significant difference. The external orifices measured were 2.96 ± 1.0 mm and 3.8 ± 0.89 mm, respectively (NS). Sixty per cent of the UCFs treated with cyanoacrylate were completely closed and 68% of the surgical group healed completely (NS). More than one reoperation to improve complications was needed in the surgical group (3.5 ± 1.2). The clinical significance of the therapeutic usefulness of OCA was demonstrated by an ARR of 0.08, RRR of 0.25 and NNT of 12 to avoid further surgical treatment. The total costs of adhesive applications and reoperations were US 158,538.50, respectively.
Conclusions:
The results showed a similar success rate for both treatments. However, sealant use should be considered before surgical treatment because this is a simple outpatient procedure with a reasonable success rate.
Trial registration:
ClinicalTrials.gov Identifier: NCT02115191. Date: April 13, 2014.
Violence and abuse (V/A) is recognized as a significant public health problem, especially in females. Injuries to the head, neck, and/or mouth are clearly visible to the dental team during examination. This article provides compelling evidence that supports the pivotal position occupied by oral health care professionals within the arena of detection, intervention, and prevention of V/A. This article reviews the epidemiology of orofacial risk factors for V/A, diagnostic tools and surveys for identifying victims of all ages, and suggests interdisciplinary educational curricula/specific algorithms to provide the necessary core competencies for identifying victims in the oral health care environment.
The attitude of French dentists concerning domestic abuse has hardly ever been documented upon so far. The purpose of this study is to investigate the attitudes, knowledge and practices of a population of French general dental practitioners towards the prevention and detection of signs of neglect and abuse in order to determine the educational needs both during undergraduate curriculum and continuing education sessions.
A total of 418 general dental practitioners all practising in the French area of Puy de Dôme were invited to participate in the study. The survey was conducted with questionnaires including multiple-choice or open questions and VAS scales.
The response rate was 54% (228/418). Only 5.7% of the practitioners systematically look for signs of neglect or abuse when treating their patients. 36% declare having already come across one or several cases of abuse and 48% having suspected at least one. The patients concerned were mainly women (54%). Only 28% would adopt an attitude in compliance with the French legislation if confronted with a case of abuse or domestic violence. 75.9% of the practitioners would like more training and assistance in the detection and care of abused patients and particularly as regards signs of abuse and the legal framework.
More information and training concerning abuse and domestic violence is required in the French undergraduate dental curriculum in order to help practitioners deal with such patients.
• To evaluate urethrocutaneous fistula repair after urethroplasty using n-butyl cyanoacrylate (NBCA) in an outpatient setting. • To compare results of application of NBCA in 'early' and long-standing fistulae.
• From January 2003 to December 2006, 13 children (mean age 36 months) were treated in our Outpatient Department for urethrocutaneous fistula, which occurred after hypospadias repair. • We analysed the data dividing the patients in two groups: group A comprised six children (mean age 22.6 months) that developed a fistula within 2-3 days of catheter removal after urethroplasty ('early' fistula) and group B comprised seven children (mean age 42.6 months) with long-standing fistulae. • In all patients, a multilayer of NBCA was applied, attaching the edges of the fistula taking care to perform a scarification of the edges of the fistula in patients in group B before the application of the glue.
• Four patients in group A and three patients in group B had definitive fistula repair (seven of 13), and six of the 13 had fistula recurrence. • Fistulae of ≤ 2 mm were more easily repaired than fistulae of > 2 mm (five of seven vs two of six). • Fistulae that tended to recover were those that responded to the first applications.
• In this experience the use of NBCA as a minimally invasive treatment for fistula repair gave good results for repairing fistulae. • These preliminary results encourage the use of NBCA as a first non-surgical attempt to repair urethrocutaneous fistulae especially if the fistula is ≤2 mm. • The failure of this procedure does not compromise a possible subsequent surgical repair.
Background:
Domestic violence exists in all communities across the world. Healthcare services have a pivotal role in the identification, assessment and response to domestic violence. As the face is a common target in assault, dentists and oral and maxillofacial surgeons are in a unique position to screen for domestic violence in the context of presentation of dental and facial injury. Owing to lack of training, dentists and oral and maxillofacial surgeons may not be the best persons to give advice to someone experiencing domestic violence. Improper advice such as encouragement to leave an abusive relationship may escalate the frequency of violence. It may be more appropriate to refer to specialist agencies for intervention and support. It would, therefore be useful to know whether screening and intervention programmes are effective.
Objectives:
(1) To assess the benefits and harms of intervention programmes employed to reduce and or prevent domestic violence in adults with dental and/or facial injuries. (2) To assess the benefits and harms of screening and the use of different screening tools in the detection of the proportion of adult victims of domestic violence who present with dental and/or facial injury.
Search strategy:
The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 18 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 18 May 2010), EMBASE via OVID (1980 to 18 May 2010), PsycINFO via OVID (1950 to 18 May 2010), LILACS via BIREME (1982 to 18 May 2010) and CINAHL via EBSCO (1980 to 18 May 2010). There were no restrictions regarding language or date of publication.
Selection criteria:
Randomised controlled trials (RCTs) involving adults aged 16 years and over presenting with dental and/or facial injury relating to domestic violence in any healthcare setting.
Data collection and analysis:
Screening of eligible studies was conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors.
Main results:
No eligible RCTs were identified.
Authors' conclusions:
There is no evidence from RCTs to support or refute that screening for domestic violence in adults with dental or facial injury is beneficial nor that it causes harm. Screening tools to detect domestic violence exist but no RCTs have specifically evaluated their effectiveness for patients presenting with facial and or dental injuries. There is also lack of evidence (from RCTs) that intervention programmes are effective at reducing frequency of physical assaults and at reducing the severity of facial injuries.
to quantify head and neck injuries in known adult victims of intimate-partner violence (IPV).
retrospective chart review.
sexual assault and domestic violence program in a southeastern Ontario hospital.
all subjects over the age of 16 years consenting for evaluation by a domestic violence nurse from August 2004 until February 2009 were eligible for inclusion. Subjects for which no physical injury was documented were excluded. Data were extracted from body maps and surveys completed by a specially trained domestic violence nurse. Demographic data, mechanisms of injury, relationship to the assailant, and a history of IPV from the same assailant were collected from the survey. The type and anatomic location of the injury were collected from body maps. Injuries were categorized into six larger categories for analysis according to general anatomic area and multiplicity of areas involved.
anatomic location of the injury.
one hundred eight visits were eligible for inclusion in the study. Data on 657 injuries were recorded. The frequency of any head and neck injury was significantly greater than no head and neck injury (p < .001). In subjects experiencing multiple areas of injury, head and neck injuries were significantly more common than not (p < .001). In subjects experiencing only one area of injury, head and neck injuries were more common than lower extremity injuries alone (p = .003) and trunk injuries alone (p = .033) but not significantly more common than upper extremity injuries (p = .102).
head and neck injuries are more common than not in known adult victims of IPV.
Aminoglycosides (AG) are widely prescribed despite their notorious toxicity. These antibiotics cause irreversible hearing loss, starting with high frequencies and progressing toward conversational frequencies (0.5-2 kHz), by destroying the acoustic hair cells in the inner ear. The integrity of these cells could be analysed by recording faint sounds that they produce otoacoustic emissions (OAE). The aim of the present study was to monitor and to characterise the acoustic toxicity of the AG using an OAE analyser.
We performed a prospective study of 49 patients receiving gentamicin (G), during 2007-2008. We made serial OAE recordings with an ILO 92 analyser (1-8 kHz) on at least 3 occasions: at the start, during treatment and after the cessation of G therapy (1-6 months). The recordings were performed at the patient's bedside and did not require the active participation of the patient. The method is fast, non-invasive, accurate and does not request an ENT specialist. We included patients presenting OAE. Ototoxicity was defined using adapted ASHA (American Speech Hearing Association) criteria.
We studied 49 patients (24/25 female/male), mean age of 37.24 (3-70 years old), who received G for 4-42 days: less than 10 days--24 patients and more than 10 days--25 patients. Hearing impairment was observed in 10 patients (20.4%) and appeared during the therapy or in the next 3 months, with a loss of one or 2 high frequencies that occurred unilaterally in 9 out of 10 cases. The acoustic damage correlates with the length of G treatment. We did not find a statistical correlation between the degree of impairment and the age, regimen or addition of another ototoxic drug, although the hearing loss was slightly higher in those with concomitant exposure.
OAE monitoring of AG treatment is a very useful way for detecting and preventing acoustic toxicity, because it could warn about hearing loss before damage of the conversational frequencies. The accuracy is similar to the classical methods, but it is faster and easier to perform.
Antiphospholipid antibodies (aPL) are considered to be contributory factors in the development of thrombotic events. The objective of the study was to determine if aPL are involved in the pathogenesis of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus. IgG anticardiolipin antibodies (IgG aCL), lupus anticoagulant (LA), and anti-IgG beta2-glycoprotein I antibodies (anti-beta2-GPI) were prospectively tested in 34 patients with DR (group 1), 20 males and 14 females, range of age 52-79 years, mean age 57 +/- 4.6 years, duration of diabetes 8-15 years, as compared to 29 type 2 diabetic patients without DR (group 2), 19 males and 10 females, range of age 54-77 years, mean age 58 +/- 4.8 years, duration of diabetes 10-13 years, and to 31 controls matched for age and sex (group 3). IgG aCL and anti-beta2-GPI were detected by enzyme-linked immunosorbent assay (ELISA) and LA was detected by activated partial thromboplastin time, kaolin clotting time, dilute Russell's viper venom time, dilute prothrombin time. Comparison between patients and controls and patients group were expressed as relative risk with its 95% confidence interval (RR [95%/CI], where a lower limit > 1.0 was considered significant. All values were determined by Fischer's exact test. A value of p < 0.05 was considered statistically significant. The incidence of IgG aCL positive (low 4-15 GPL U IgG aCL titers) in group 1 was 21/34 (62%) vs. 12/29 (41%) in group 2 (RR 1.460 95% CI [0.9052 to 2.382]), p = 0.1330. The incidence of LA positive in group 1 was 27/34 (79%) vs. 8/29 (28%) in group 2 (RR 3.086 95% CI [1.584 to 6.010]), p < 0.0001. The incidence of anti-IgG beta2-GPI positive in group 1 was 29/34 (85%) vs. 6/29 (21%) in group 2 (RR 4.640 95% CI [2.067-10.418]), p < 0.0001. The results suggest the possible participation of anti-beta2-GPI and LA in the pathogenesis of DR, shifting the hemostatic balance toward a pro-thrombotic state increasing the risk of developing thrombosis.
The evaluation of atherosclerosis, by the measurement of intima media thickness (IMT) at the level of right common carotid arteries (CCA Right) and left (CCA Left), for normolipidemic patients (NL) and dislipidemic patients (DLP) with various degrees of alteration to glucose tolerance. DESIGN AND METHODS OF RESEARCH: We have analyzed a group of 120 NL patients and a group of 120 DLP patients. The test of orally provoked hyperglycemia was performed to assess the disturbance of tolerance to glucose. IMT was determined by the method of ultrasonography in model 2B at the level of right and left common carotid arteries, measured at 2 cm from the bifurcation of common carotids.
For patients with DLP the IMT medium was statistically higher than the group of NL patients. The normoglycemic normolipidemic patients (NGNL) presented a lower IMT value than the normoglycemic dislipidemic patients (NGDLP). For the group of DLP patients, IMT was statistically higher for patients with pre-diabetes (ALT)--impaired fasting glycaemia (IFG) and the impaired glucose tolerance (IGT)--compared to NG patients (with statistical signification).
The presence of sub-clinic atherosclerosis objected through IMT was higher for DLP patients compared to NL patients demonstrating the role of dyslipidemia in the production of atherosclerosis. For patients with diabetes (DM), of both groups, the value of IMT was higher as compared to NG patients, demonstrating the influence of hyperglycemia in the production of atherosclerosis.
Stroke is the third cause of death, after heart disease and cancer. Diabetes mellitus is one of the risk factors for stroke and its incidence is increasing, leading to an accentuation of the risk of stroke. We explored the relationship between diabetes and types of stroke, risk factors for the latter one, both in subjects with diabetes and in those without diabetes.
The study was conducted on two groups that included 228 subjects; group 1-136 diabetic patients and stroke recently installed; group 2-92 patients without diabetes but stroke recently installed, hospitalized in the Neurologic Department of the County Emergency Hospital, Vâlcea during 2006-2008. On every batch we have made biochemical measurements: glycemic profile, lipid profile, we have established normal values for every group (nondiabetics and diabetic subjects), we determined the type and location of stroke as the result of CT. Statistical analysis was performed using SPSS 15 for Windows application, adapted to processing medical statistics. They calculated the average of the parameters, standard deviation, standard deviation of the average, frequency ranges, tables frequency tests of statistical significance by Student method (t test), and calculation ofHi2 score. We calculated Pearson correlation coefficients that we have interpreted using the rules of Colton.
In both groups ischaemic stroke predominated - 116 (85%) cases in diabetics and 68 (74%) cases in nondiabetics; haemorrhagic stroke was approximately equal in diabetics and nondiabetics 20 (15%) cases vs. 24 (26%) cases. The average age was significantly higher in group 2 versus group 1 (p = 0.026*). Most of the 2nd group subjects are from rural areas, while in 1st group they are from the urban areas. Hypertension was mostly a pre-existing risk factor in both groups. Serum lipid was over the values recommended in both groups. The index of insulinoresistance, materialized by HOMA-IR, was present in 80% of subjects of 1st group and in 52% of subjects of the 2nd group. The incidence rate of stroke was much higher in diabetic population than in the nondiabetics between 2006 and 2008.
Stroke is installed at a younger age in diabetic subjects than in nondiabetic ones and it is more frequent in nondiabetic males; insulinoresistance is a risk factor present in both groups, but we found a statistical significance only in group 2.
It is very well known that in clinical practice, according to the published guidelines, the heart failure patients are undertreated. There are striking differences in applying the guidelines in various countries and, up to the present, there are no consistent data for Romania.
There were studied 459 heart failure patients admitted in the Cardiology Department of a general hospital in Cluj-Napoca, Romania. They were evaluated from the point of view of the drugs used during hospitalization and recommended to be taken after discharge.
The patients, 393 males and 66 females, aged 61+9 years (lower in comparison with other countries) were included in NYHA III and IV class, except 3%, in NYHA II class. The ischemic etiology was registered in 56% of the patients. Drug treatment was as follows: diuretics--86.98%, ACEI--77.77%, beta blockers--55.95, ARB's--7%, digoxin--51.63%, aldosterone antagonists--49%, nitrates--61.28%, statins--24%, antithrombotic therapy--60% (antiplatelet--45.75%, anticoagulants--28.5%), antiarrythmics--27.91% (mainly amiodarone). In comparison with other European countries, the use of RAAS antagonists is similar, there are more beta blockers and nitrates used, but there is less use of antithrombotic therapy (especially anticoagulation) and of statins.
Even though Romania still belongs to the group of developing countries, the drug treatment of heart failure patients does not much differ from the treatment applied in developed countries.
Cyanoacrylate tissue compounds are marketed as a surgical wound dressing with a variety of properties including microbiological impermeability. This study compares the bacteriological impermeability of cyanoacrylates and a commonly used occlusive adhesive dressing using a technique established in several other studies. Cyanoacrylate compound and an occlusive dressing were applied to both CLED and CROM agar plates. S. Aureus and E. Coli was then applied in a range of concentrations. The work demonstrated that cyanoacrylate compound provides as occlusive a barrier to microbiological penetration as adhesive dressings.
Health care professionals have increasingly recognized that intimate partner violence (IPV) is a highly prevalent public health problem with devastating effects on individuals, families, and communities. However, there are no obvious clinical characteristics of IPV. Interventions may prevent future IPV-related injuries, but they cannot be initiated until the diagnosis is made. Because of the frequency of IPV-related orofacial injuries, oral and maxillofacial surgeons (OMSs) may be the first and only health care providers to see these patients. Therefore, OMSs are in a pivotal position to diagnosis IPV-related injuries and expedite referral for interventional therapy. This article presents data that support the use of orofacial injuries as a prime predictor variable in identifying victims of IPV and provides: (1) an overview of the epidemiology of IPV-related orofacial injuries; (2) a discussion of the role of head, neck, and facial injuries as markers of IPV, and their role as a diagnostic tool to facilitate the early diagnosis and referral for management of IPV; (3) a list of the advantages and limitations of using orofacial injuries as indicators of IPV; and (4) future directions to improve efforts to educate OMSs in identifying patients who are at high risk for an IPV-related injury.
To determine if patterns of facial injuries differed between those of female assault victims with maxillofacial injuries and those of female patients with maxillofacial injuries from other causes.
We reviewed the medical and dental records of 326 adult female facial trauma patients treated by otolaryngologists and oral/maxillofacial surgeons at the University of Kentucky Medical Center. Information abstracted included date of injury, dates of presentation for medical attention, mechanism(s) of injury, diagnoses, and treatments.
While victims of intimate partner violence were more likely to have zygomatic complex fractures, orbital blow-out fractures, and intracranial injuries than were other patients with facial trauma, women assaulted by unknown or unidentified assailants were more likely to have mandible fractures (P = .004).
These results in conjunction with other presenting circumstances, such as delay in presentation, can assist the surgeon treating patients with maxillofacial injury in recognizing interpersonal violence against women.
An unhurried, deft, economical technique allied to efficient use of available resources, surgical instruments and support staff is the hallmark of a 'good' surgeon. To achieve this sense of fluency, surgeons need to be familiar with the tools of their profession so that these can be employed appropriately for the task at hand. The range of instruments available in obstetrics and gynaecology is no less wide or complex than in any other branch of surgery, but formal teaching in the full range of surgical hardware is frequently lacking and an individual's exposure is generally limited to the instruments used in his or her own training hospital. This chapter sets out to describe key technical areas with which surgeons need to be familiar.
We identified factors that influence patient perceptions of their skin cancer surgery through a prospective study of patients referred to a single surgeon during 18 months.
Patients having surgery resulting in a wound sutured and dressed were surveyed 6 to 9 months later. Monitoring for complaints continued for 3 years.
In all, 74% of patients returned the survey (576 of 778). A total of 250 (43%) rated their scar excellent, 177 (31%) very good, 72 (12.5%) good, 40 fair (6.9%), and 14 (2.4%) poor or very poor. Age, sex, diagnosis, or closure method did not result in a variation in scar perception. In all, 27.3% of scars (21/77) on the trunk were rated neutral or negative compared with 6.9% (33/476) of scars elsewhere (P < .001) and only 5% (15/305) of head and neck scars (P < .001). Complications did not change scar or overall evaluation ratings. In all, 393 patients (68%) rated the overall service excellent, 145 (25%) very good, 22 (4%) good, and 3 (0.5%) fair. No patient rated the service poor or very poor. Patients rating the service lower were most dissatisfied with scar appearance, time waiting before surgery, pain from the local anesthetic, nursing care, follow-up care, cost, and written material. In all, 99% of patients who rated their scar very good or excellent rated the overall service optimally, compared with only 85% of patients who rated their scar as good or worse.
A single experienced surgeon in a southern Australia locale might not reflect the perceptions in other clinicians and locations.
Complications and patient complaints do not identify patient dissatisfaction from cutaneous surgery. The patients' perception of their scars markedly influences their overall service perception. Patients experienced more dissatisfaction with repairs on the trunk.
A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence.
The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence.
Systematic review.
At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under-detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information.
Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented.
The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self-efficacy.
Violence and abuse affect one in four women during their lifetime. Specifically, a woman seeking treatment of a facial injury has a one in three chance of being a victim of violence and abuse. Many dental professionals, however, are uncomfortable discussing these issues with potential victims. The oral and maxillofacial surgeon is in a unique position to approach the topic of violence and abuse. This article discusses violence and abuse as it pertains to the female patient and family members. Suggestions for screening and evaluation of patients are discussed. The overall importance of timely identification for stopping this cycle of violence and abuse and the obligations of health care providers are also addressed.
The current research was designed to examine the impact of providing short-term advocacy services to women leaving battered women's shelters. Previous research has suggested that a critical reason so many women remain with or return to their abusive partners is lack of access to community resources necessary for independent living. This study employed a true experimental design and was longitudinal, interviewing women four times over the first five months after they left a battered women's shelter. Women in the experimental condition received intensive, one-on-one services with trained paraprofessional advocates for a period of 10 weeks. Advocates assisted women in gaining access to needed community resources. Women in the control condition received no additional services. Findings corroborated earlier research that suggested that battered women often lack many resources needed to live independently of their assailants. Results further indicated that women who worked with advocates reported being more effective in accessing resources than did the women in the control condition. Implications for further research are discussed.
Presented the 6-month follow-up findings of an experimental intervention designed to provide postshelter advocacy services
to women with abusive partners. The intervention involved randomly assigning half the research participants to receive the
free services of an advocate, 4 to 6 hours per week, for the first 10 weeks postshelter. One hundred forty-one battered women
were interviewed about their experiences immediately upon their exit from a domestic violence shelter: 95% of the sample were
interviewed 10 weeks thereafter (postintervention), and 93% were successfully tracked and interviewed 6 months later. At the
6-month follow-up, participants in both groups reported increased social support, increased quality of life, less depression,
less emotional attachment to their assailants, and an increased sense of personal power. Although women in both groups reported
some decrease in physical abuse over time, there were no statistically significant differences between those with and those
without advocates, and abuse continued to be a problem for many women. Those who were still involved with their assailants
continued to experience higher levels of abuse and had been more economically dependent upon the men prior to entering the
shelter. Women who had worked with advocates continued to report being more satisfied with their overall quality of life than
did the women in the control group.
Violence against women is a major health problem around the world. It often goes unnoticed and undocumented partly due to its taboo nature. A number of recent studies have explored the extent and patterns as well as the health consequence of violence in different cultures. The studies cited indicate that violence against women is widespread and an important cause of morbidity and mortality among women. Injuries due to violence have only recently been recognized as an important public health problem. More research is needed to improve our understanding of gender violence, and to design better interventions.
An intensive community-based advocacy intervention was designed and evaluated by randomly assigning 278 battered women to an experimental or control condition. Participants were interviewed 6 times over a period of 2 years. Retention rate averaged 95% over the 2 years. The 10-week postshelter intervention involved providing trained advocates to work 1-on-1 with women, helping generate and access the community resources they needed to reduce their risk of future violence from their abusive partners. Women who worked with advocates experienced less violence over time, reported higher quality of life and social support, and had less difficulty obtaining community resources. More than twice as many women receiving advocacy services experienced no violence across the 2 years postintervention compared with women who did not receive such services.
Three different 12-month interventions for servicemen who had been substantiated as having physically assaulted their wives were used and the outcomes examined. The 861 couples of the study were randomly assigned to 4 groups: a men's group, a conjoint group, a rigorously monitored group, and a control group. Cognitive-behavioral interventions were implemented for the men's and conjoint groups, and outcome data were gathered from male perpetrators and female victims at roughly 6-month intervals over the approximately 18-month experimental period. Data analyses revealed nonsignificant differences between the experimental groups over a variety of outcome measures.
To assess the evidence for the acceptability and effectiveness of screening women for domestic violence in healthcare settings.
Systematic review of published quantitative studies. SESRCH STRATEGY: Three electronic databases (Medline, Embase, and CINAHL) were searched for articles published in the English language up to February 2001.
Surveys that elicited the attitudes of women and health professionals on the screening of women in health settings; comparative studies conducted in healthcare settings that measured rates of identification of domestic violence in the presence and absence of screening; studies measuring outcomes of interventions for women identified in health settings who experience abuse from a male partner or ex-partner compared with abused women not receiving an intervention.
20 papers met the inclusion criteria. In four surveys, 43-85% of women respondents found screening in healthcare settings acceptable. Two surveys of health professionals' views found that two thirds of physicians and almost half of emergency department nurses were not in favour of screening. In nine studies of screening compared with no screening, most detected a greater proportion of abused women identified by healthcare professionals. Six studies of interventions used weak study designs and gave inconsistent results. Other than increased referral to outside agencies, little evidence exists for changes in important outcomes such as decreased exposure to violence. No studies measured quality of life, mental health outcomes, or potential harm to women from screening programmes.
Although domestic violence is a common problem with major health consequences for women, implementation of screening programmes in healthcare settings cannot be justified. Evidence of the benefit of specific interventions and lack of harm from screening is needed.
Intimate partner violence is prevalent and is associated with significant impairment, yet it remains unclear which interventions, if any, reduce rates of abuse and reabuse.
To systematically review, from the perspective of primary health care, the available evidence on interventions aimed at preventing abuse or reabuse of women.
MEDLINE, PsycINFO, CINAHL, HealthStar, and Sociological Abstracts were searched from the database start dates to March 2001 using database-specific key words such as domestic violence, spouse abuse, partner abuse, shelters, and battered women. References of key articles were hand searched. The search was updated in December 2002.
Both authors reviewed all titles and abstracts using established inclusion/exclusion criteria. Twenty-two articles met the inclusion criteria for critical appraisal.
Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, both authors independently reviewed the 22 included studies using an established hierarchy of study designs and criteria for rating internal validity. Quality ratings of individual studies--good, fair, or poor--were determined based on a set of operational parameters specific to each design category developed with the US Preventive Services Task Force.
Screening instruments exist that can identify women who are experiencing intimate partner violence. No study has examined, in a comparative design, the effectiveness of screening when the end point is improved outcomes for women (as opposed to identification of abuse). No high-quality evidence exists to evaluate the effectiveness of shelter stays to reduce violence. Among women who have spent at least 1 night in a shelter, there is fair evidence that those who received a specific program of advocacy and counseling services reported a decreased rate of reabuse and an improved quality of life. The benefits of several other intervention strategies in treating both women and men are unclear, primarily because of a lack of suitably designed research measuring appropriate outcomes. In most cases, the potential harms of interventions are not assessed within the studies reviewed.
Much has been learned in recent years about the epidemiology of violence against women, yet information about evidence-based approaches in the primary care setting for preventing intimate partner violence is seriously lacking. The evaluation of interventions to improve the health and well-being of abused women remains a key research priority.
This paper presents a new short-form scale called the Index of Spouse Abuse or ISA that was designed for use in clinical settings to monitor and evaluate progress in treatment. The ISA can be used on a regular or periodic basis with a single client in order to evaluate change in the degree or severity of both physical and nonphysical abuse as perceived by female respondents. The paper presents detailed findings concerning the reliability and validity of the ISA, along with details concerning the administration, scoring, and interpretation of the scale.
Examined the short-term impact of providing advocacy services to women leaving battered women's shelters. The study employed a true longitudinal experimental design. Women in the advocacy condition received intensive one-on-one services with trained paraprofessional advocates. Advocates assisted women in accessing needed community resources. Women in the control condition received no additional postshelter services. Findings corroborated earlier research suggesting that battered women lack many resources necessary for independent living and that working with advocates produced greater effectiveness in accessing needed resources. Ongoing research will examine the long-term impact on life satisfaction, future victimization, and living arrangements.
In response to the need for more sensitive assessment instruments, scales were developed applicable to the evaluation of male violence against women. Two versions of the Severity of Violence Against Women Scale (SVAWS) were developed. On 10-point scales, college females (N = 707) rated how serious, aggressive, abusive, violent, and threatening it would be if a man carried out each of 46 acts with a woman. The mean of each act across ratings was calculated and submitted to factor analysis. Nine factors represented symbolic violence: threats of mild, moderate, and serious violence; actual mild, minor, moderate, and serious violence; and sexual violence. Community women (N = 208) rated the acts on seriousness, aggressiveness, and abusiveness. All factors were unidimensional. Second-order factor analysis confirmed the existence of two broader dimensions representing physically threatening acts and actual violence. Ratings of the amount of physical and emotional harm provided the weightings for future research with student (SVAWS-S) and adult (SVAWS) samples.
Experimentally tested the hypotheses that (1) battered women are in need of numerous community resources upon exit from a domestic violence shelter, (2) working with advocates increases women's effectiveness in obtaining needed resources and social support, and (3) success in obtaining resources and social support increases women's levels of life satisfaction and decreases their risk of further abuse. The initial findings of a short-term intervention project designed to provide postshelter advocacy services to women with abusive partners are presented. One-hundred forty-one battered women were interviewed immediately upon their exit from a domestic violence shelter as well as 10 weeks thereafter. Half the sample was randomly assigned to receive the services of trained advocates who assisted them in accessing needed community resources. Women who worked with advocates reported being more effective in accessing resources and had higher levels of social support and overall quality of life postintervention. Although all women reported some decrease in postshelter abuse, there were no differences between those with and those without advocates, and abuse continued to be a problem for many women.
The study retrospectively investigated variations in the use of secondary healthcare for head injury, particularly assault. A total of 25,300 emergency head-related admission were examined over a two-year period, of which 3756 were for assault. More males were admitted during summer and holiday periods, while there were fewer female patients with head injuries and the incidence varied less. The largest number of admissions was among men aged 15-44 and most assaults occurred at weekends. Females were more likely than males to die from all head injuries (OR=1.31) and violent head injuries (OR=2.38). Women (15+) stayed longer in hospital than males. Injuries among males are primarily associated with social occasions. Females experience head injuries all the year round suggesting that these injuries are the result of domestic violence. There are important demographic differences in numbers of patients and duration of hospital care required to treat these avoidable injuries.
Routine screening for intimate partner violence (IPV) is endorsed by numerous health professional organizations. Screening rates in health care settings, however, remain low. In this article, we present a review of studies focusing on provider-specific barriers to screening for IPV and interventions designed to increase IPV screening in clinical settings.
A review of published studies containing original research with a primary focus on screening for IPV by health professionals was completed.
Twelve studies identifying barriers to IPV screening as perceived by health care providers yielded similar lists; top provider-related barriers included lack of provider education regarding IPV, lack of time, and lack of effective interventions. Patient-related factors (e.g., patient nondisclosure, fear of offending the patient) were also frequently mentioned. Twelve additional studies evaluating interventions designed to increase IPV screening by providers revealed that interventions limited to education of providers had no significant effect on screening or identification rates. However, most interventions that incorporated strategies in addition to education (e.g., providing specific screening questions) were associated with significant increases in identification rates.
Barriers to screening for IPV are documented to be similar among health care providers across diverse specialties and settings. Interventions designed to overcome these barriers and increase IPV-screening rates in health care settings are likely to be more effective if they include strategies in addition to provider education.
The purpose of this study was to report the incidence, causes, and patterns of maxillofacial injury associated with domestic violence.
A retrospective review of patients treated for domestic violence injuries at an inner-city hospital over a 5-year period was done, and data were collected on type and location of injury, mechanism of injury, alcohol involvement, and treatment.
The sample consisted of 236 emergency room admissions. The majority (81%) of victims presented with maxillofacial injuries. The fist was a favorite means for assaults (67%). The middle third of the face was most commonly involved (69%). Soft tissue injuries were the most common type of injury (61%). Facial fractures were present in 30% of victims. The average number of mandible fractures per patient was 1.32. The majority of facial fractures (40%) were nasal fractures. Left-sided facial injuries were more common than right sided.
These data confirm that most victims of domestic violence sustain maxillofacial injuries. Midface injuries predominate. The preponderance of facial injuries makes it very likely that oral and maxillofacial surgeons will be involved in the care of these patients.
In 1998 a cross-sectional study of violence against women was undertaken in three provinces of South Africa. The objectives were to measure the prevalence of physical, sexual and emotional abuse of women, to identify risk factors and associated health problems and health service use. A multi-stage sampling design was used with clusters sampled with probability proportional to number of households and households were randomly selected from within clusters. One randomly selected woman aged 18-49 years was interviewed in each selected home. Interviews were held with a total 1306 women, the response rate was 90.3% of eligible women. For the risk factor analysis, multiple logistic regression models were fitted from a large pool of candidate explanatory variables, while allowing for sampling design and interviewer effects. The lifetime prevalence of experiencing physical violence from a current or ex-husband or boyfriend was 24.6%, and 9.5% had been assaulted in the previous year. Domestic violence was significantly positively associated with violence in her childhood, her having no further education, liberal ideas on women's roles, drinking alcohol, having another partner in the year, having a confidant(e), his boy child preference, conflict over his drinking, either partner financially supporting the home, frequent conflict generally, and living outside the Northern Province. No significant associations were found with partners' ages, employment, migrant status, financial disparity, cohabitation, household possessions, urbanisation, marital status, crowding, communication, his having other partners, his education, her attitudes towards violence or her perceptions of cultural norms on women's role. The findings suggest that domestic violence is most strongly related to the status of women in a society and to the normative use of violence in conflict situations or as part of the exercise of power. We conclude by discussing implications for developing theory on causal factors in domestic violence.
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